Ch 22 Meds For Psychotic Disorders Flashcards
2nd generation ATYPICAL ANTIPSYCHOTICS are used to treat what
It is the med of choice for clients receiving initial treatment, and for treating breakthrough episodes in clients on conventional medication therapy. They have fewer adverse effects
What are advantages of ATYPICAL ANTIPSYCHOTICS
Relief of both positive and negative symptoms
Decrease in affective findings ( depression, anxiety) and siucidal behaviors.
Improvement of neurocognitive defects such as poor memory
Fewer EPS symptoms, including Tardive kinesia due to less dopamine blockade.
Fewer anticholinergic effects
Less relapse
What is the prototype typical antipsychotic
Chlorpromazine ( Thorazine) low potency
What are other typical antipsychotic meds
Haloperidol.... High potency Fluphenazine ....... High potency Loxapine...... Medium potency Thioridazine .....,.. Low potency Thiothixene ( Navane) high potency Perphenazine.... Medium potency Trifluoperazine .....high potency
What is the expected pharmacological action of typical antipsychotics
Blocks dopamine, acetylcholine, histamine, and norepinephrine receptors in the brain and periphery.
Inhibition of psychotic symptoms is believed to be a result of dopamine blockade in the brain.
What are therapeutic uses of typical antipsychotics
Treatment of acute and chronic psychotic disorders
Schizophrenia spectrum disorders
Bipolar disorder- primarily The manic phase
Tourette’s syndrome
Prevention of N/V through blockage of dopamine
What are complications of typical antipsychotics
AGRANULOCYTOSIS- observe for fever, sore throat…. Obtain baseline WBC, discontinue meds if signs of infection are present
ANTICHOLINERGIC EFFECTS
EPS SYMPTOMS- acute dystonia
Parkinsonism, Akathisia, Tardive dyskinesia, neuroendocrine effects, neuroleptic malignant syndrome, orthostatic hypotension, sedation, seizures, severe dysrhythmias, sexual dysfunction, skin effects.
What is acute dystonia
A adverse effect of typicals: Severe spasm of the tongue, neck, face and back.
Begin to monitor for acute dystonia within 5 hr to 5 days after giving 1st dose of typical antipsychotic.
Treat with anticholinergic agents such as benztropine ( cogentin) or diphenhydramine ( Benadryl)
What is Parkinsonism
A adverse effect of typicals….. Symptoms include bradykinesia, rigidity, drooling, tremors…
Observer for this the first month of treatment
Treat with benztropine, diphenhydramine, or amantadine ( symmetrel)
Akathisia
A adverse effect of typicals, symptoms include the inability to sit down, and continual pacing and agitation.
Observer for this the first 2 months of treatment
Treat with beta blockers, benzodiazepines, or ANTICHOLINERGICs
What are side effects of typical antipsychotics
Gynecomastia,gallactorrhea, menstrual irregularities
What are 1st generation antipsychotics used to treat
They are used mainly to control positive symptoms of psychotic disorders and are reserved for those who can tolerate the adverse effects. And those who are violent or aggressive
What is are nursing interventions of NMS
Stop anti psychotic med
Monitor VS, apply cooling blankets, give antipyretics, increase fluid intake, administer dantrolene ( Dantrium) & bromocriptine to induce muscle relaxation
Wait 2 weeks before continuing therapy consider switching to a atypical.
What is akathisia and what are nursing interventions
Inability to sit or stand still continual pacing & agitation
Observe 4 this the 1st 2 months of tx, manage with beta blockers, benzodiazepines or anticholinergic meds such as cogentin or artane
What are contraindications of typical antipsychotics
Ppl in a coma,severe depression, Parkinson’s, prolactin dependent cancer of the breast, severe hypotension
What are meds to avoid while on typical antipsychotic therapy
Concurrent use of anticholinergic meds can put the pt into a anticholinergic crisis. ( sleep aids contain anticholinergic agents)
Other CNS depressants such as alcohol, opioids,and antihistamines can further depress the CNS
Levodopa counteracts the effects of typical antipsychotics
What tool screens for the presence of EPS
ABNORMAL INVOLUNTARY MOVEMENT SCALE (AIMS)
What should be administered to control early signs of EPS
ANTICHOLINERGICS,BETA BLOCKERS, BENZODIAZEPINES
Do antipsychotics cause addiction
No
Name 2nd generation atypical meds
Prototype; risperidone ( Risperdal) Aripriprazole (Abilify) Asenapine (Saphris) Clozapine ( clozaril) Iloperidone ( Fanapt) Olanzapine ( Zyprexa) Paliperidone ( Invega) Quetiapine ( Seroquel) Ziprasidone ( Geodon)
What are the therapeutic uses of atypical antipsychotics
Positive and negative symptoms
Psychosis induced by levodopa therapy
Relief of psychotic manifestations in other disorders such as bipolar
What are adverse effects of atypicals
New onset diabetes
Wt gain
Hypercholesteremia
Orthostatic hypotension
Anticholinergic effects, mild EPS such as tremor
Agitation,dizziness, sedation, sleep disruption
What is education for the atypical antipsychotic
Asenapine
Avoid eating and drinking for 10 min after taking
What is education for the typical lurisidone
Eat with food to increase absorption
